We propose to assess the role of cardiovascular disease (CVD) risk estimation in veterans without cancer or other major illnesses and compare the utility of using US national guideline estimates from ATP4 versus VA-specific formulations developed from VISN 1 and VISN 7. The core variables that will be used include traditional risk factors such age, sex, race, blood pressure, smoking, cholesterol, HDL cholesterol and diabetes status. In addition, we propose to identify the best ways to assess CVD risk in veterans with diabetes mellitus and in veterans who have already experienced a CVD event. We will evaluate the precision and accuracy of the ATP4 estimating equations in the VA and separately develop CVD risk equations using ATP4 variables to evaluate the best approach to estimate CVD risk in veterans. This critical evaluation of the risk of CVD in veterans is aimed to provide effective and convenient risk assessment tools - that in the future could be incorporated into clinical care for outpatient veterans and has the potential to guide CVD preventive therapy within the VA so that resources can be aligned to intervene appropriately with cardiovascular preventive services in veterans at high risk for developing a future CVD event. This proposal has direct relevance to the health risks of risky behavior (cigarette smoking), women's health, and patient-centered care.